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General NPI Number Information
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NPI Number | 1619563632
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Entity Type | Organization
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Legal Business Name | FREEDOM CHIROPRACTIC
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 1302 BECK AVE STE A
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City | CODY
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State | WY
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Zip | 82414-3758
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Country | US
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Telephone | 307-586-5301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2230
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City | CODY
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State | WY
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Zip | 82414-2230
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Country | US
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Telephone | 307-586-5301
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KENDRA SUDDARTH
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Credential |
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Telephone | 907-590-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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